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Protocol - Skin Cancer

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Protocol Name from Source:

The Expert Review Panel has not reviewed this measure yet.

Availability:

Publicly available

Description:

The protocol developed by Quereux et al. (2010) includes a self administered questionnaire that captures the main skin cancer risk factors, such as skin type, presence of freckles and moles, occurrence of blistering sunburns and personal and family history of melanoma. After the respondent completes the questionnaire, the physician then examines the respondent regarding the number of nevi, freckling tendency, and phototype (hair and eye color, complexion and tanning ability). Then the physician checks the answers provided by the respondent and completes the questionnaire.

Protocol:

Self-Assessment of Melanoma Risk Factors

Answer each question by putting a cross in the corresponding square (left column)

1. What type of skin do you have?

[ ] Skin-type I: very fair skin, blond or red hair, light eyes (blue or green), never tan and always sunburn after sun exposure

[ ] Skin-type II: fair skin, blond or light-brown hair, light eyes (blue or green), usual sunburn

[ ] Skin-type III: deep skin, brown hair, light to medium eye colour

[ ] Skin-type IV: olive skin, dark-brown hair, brown eyes

[ ] Skin-type V: brown skin, black hair, black eyes

[ ] Skin-type VI: black skin, black hair, black eyes

2. Do you have freckles?

[ ] Yes

[ ] No

3. How many moles do you approximately have on the whole body?

[ ] More than 50

[ ] Fewer than 50

4. Did you have one or more severe blistering sunburn as a child or teenage?

[ ] Yes

[ ] No

5. Did you live for more than one year in a country where sunshine is high (Africa, French West Indies, South of United States, Australia…)

[ ] Yes

[ ] No

6. Have you been diagnosed with melanoma in the past (it's a skin cancer, arising in melanocytes, skin cells that make skin pigment)?

[ ] Yes

[ ] No

7. Has any of your first degree relatives (parents, children, brother or sister) ever had melanoma?

[ ] Yes

[ ] No

[ ] Don't know

Note from the Skin, Bone, Muscle and Joint Working Group: After completing a physical examination, the physician selects answers for questions 8-14 below. This selection is based on the physical examination. The questions are not asked of the patient.

Physician's Assessment of Melanoma Risk Factors

8. What type of skin do you have?

[ ] Skin-type I

[ ] Skin-type II

[ ] Skin-type III

[ ] Skin-type IV

[ ] Skin-type V

[ ] Skin-type VI

9. Do you have freckles?

[ ] Yes

[ ] No

10. How many moles do you approximately have on the whole body?

[ ] > 50

[ ] < 50

11. Did you have one or more severe blistering sunburn as a child or teenage?

[ ] Yes

[ ] No

12. Did you live for more than one year in a country where sunshine is high (Africa, French West Indies, South of United States, Australia…)

[ ] Yes

[ ] No

13. Have you been diagnosed with melanoma in the past (it's a skin cancer, arising in melanocytes, skin cells that make skin pigment)?

[ ] Yes

[ ] No

14. Has any of your first degree relatives (parents, children, brother or sister) ever had melanoma?

[ ] Yes

[ ] No

[ ] Don't know

Personnel and Training Required

The interviewer must be trained and found to be competent (i.e., tested by an expert) in the conduct of physical examinations regarding nevi, freckling tendency, and phototype (hair and eye color, complexion and tanning ability).

Equipment Needs

A copy of the questionnaire for self-assessment of melanoma risk factors.

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Adult, Senior

Specific Instructions:

Questions 1-3 of the questionnaire for self-assessment of melanoma risk factors have been deleted. These questions asked the respondent's age, gender, and occupation. The PhenX Skin, Bone, Muscle and Joint Working Group (WG) recommends that this information be obtained via the PhenX measures titled Current Age, Gender, and Current Employment Status, respectively.

The Working Group recommends that as an alternative to a physician, a trained technician can conduct the physical examination.

Research Domain Information

Release Date:

November 12, 2010

Definition

This measure consists of a questionnaire and a physical examination to determine whether respondents are at risk for developing melanoma.

Purpose

This measure can be used to assess the main melanoma risk factors, such as family history, number of nevi, sun exposure, freckling tendency and skin type.

Selection Rationale

The questionnaire for self-assessment of melanoma risk factors was chosen because it has been vetted against other indexes, and for its ease of patient use, brevity, and ability to compare patient and physician assessment.

Language

English, French

Standards

StandardNameIDSource
Common Data Elements (CDE)Skin Cancer Risk Assessment Description Text3158308CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Skin cancer proto62908-9LOINC

Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

Quereux, G., Nguyen, J. M., Volteau, C., Lequeux, Y., & Dreno, B. (2010). Creation and test of a questionnaire for self-assessment of melanoma risk factors. European Journal of Cancer Prevention, 19(1), 48–54, Jan.

The questions in the protocol text section were originally numbered 4-10; these numbers have been changed to 1-7 and 8-14.

General References

None

Protocol ID:

170601

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX170601_Self_Assessed_Skin_TypePX170601010000What type of skin do you have?4N/A
PX170601_Self_Assessed_FrecklesPX170601020000Do you have freckles?4N/A
PX170601_Self_Assessed_MolesPX170601030000How many moles do you approximately have on the whole body?4N/A
PX170601_Self_Assessed_SunburnPX170601040000Did you have one or more severe blistering sunburn as a child or teenage?4N/A
PX170601_Self_Assessed_Country_High_SunshinePX170601050000Did you live for more than one year in a country where sunshine is high (Africa, French West Indies, South of United States, Australia...)4N/A
PX170601_Self_Assessed_MelanomaPX170601060000Have you been diagnosed with melanoma in the past (it's a skin cancer, arising in melanocytes, skin cells that make skin pigment)?4N/A
PX170601_Self_Assessed_Melanoma_Family_HistoryPX170601070000Has any of your first degree relatives (parents, children, brother or sister) ever had melanoma?4N/A
PX170601_Examiner_Assessed_Skin_TypePX170601080000What type of skin do you have?4N/A
PX170601_Examiner_Assessed_FrecklesPX170601090000Do you have freckles?4N/A
PX170601_Examiner_Assessed_MolesPX170601100000How many moles do you approximately have on the whole body?4N/A
PX170601_Examiner_Assessed_SunburnPX170601110000Did you have one or more severe blistering sunburn as a child or teenage?4N/A
PX170601_Examiner_Assessed_Country_High_SunshinePX170601120000Did you live for more than one year in a country where sunshine is high (Africa, French West Indies, South of United States, Australia...)4N/A
PX170601_Examiner_Assessed_MelanomaPX170601130000Have you been diagnosed with melanoma in the past (it's a skin cancer, arising in melanocytes, skin cells that make skin pigment)?4N/A
PX170601_Examiner_Assessed_Melanoma_Family_HistoryPX170601140000Has any of your first degree relatives (parents, children, brother or sister) ever had melanoma?4N/A